Drug standards tightening

An effort by federal agencies to tighten controls on hydrocodone combination drugs has had a noticeable but difficult to quantify effect on such prescriptions for injured workers.

The U.S. Drug Enforcement Administration placed hydrocodone combination products in a more restrictive category of controlled substances, alongside morphine and oxycodone, effective last October. The reclassification from Schedule III to Schedule II means that prescribers must issue a new prescription and no phone-in refills are allowed, according to the U.S. Food and Drug Administration.

Vicodin, a hydrocodone-acetaminophen combination drug, has been the No. 1 prescribed medication in Coventry Workers' Comp Services' workers comp business, but it also has had the largest decline in utilization over the past three years, dropping 7.8% last year.

“I don't know how much is attributable to the regulation specifically, but it's definitely more difficult to obtain those prescriptions,” said Dannielle Foroozandeh, Coventry's director of pharmacy product development based in Orange County, California.

Less certain is the effect of designating tramadol as a Schedule IV controlled substance last year. Schedule IV drugs are defined as having a low potential for abuse and a low risk of dependence.

“I don't think it made as big of a splash,” Ms. Foroozandeh said.

Tramadol had a 6.3% increase in utilization in 2014, according to an analysis by pharmacy benefit manager Helios published in March.

“Tramadol going up slightly is partly because of hydrocodone, because you can do refills for tramadol,” said Tron Emptage, chief clinical officer at Helios in Columbus, Ohio.